EmailMe Form - ROFF Adoption Application

Name *

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Cell Phone

### - ### - ####

Email

Date of Birth *

ROFF animal you wish to give a forever home to... *

Your place of employment

Name and ages of all people who reside in your household

Does anyone in your house have pet allergies?

Do you own or rent your home?

How long have you been at your current residence?

If you rent, please list the landlords name and contact number

Have you had a pet previously?

Do you have any other animals in your home right now?

Have you ever surrendered a pet to another party?

Do you have a fenced in yard?

Why do you want to adopt a pet?

Would you object to a background check?

Vet Reference

Vet Phone

### - ### - ####

Please list 3 personal references including contact numbers

Your Signature
(Please type in your name) *

With this "signature", I understand that I am not guaranteed a pet and that I give permission to a R.O.F.F. representative to verify that all information given in this application is true and correct. I also understand that if I cannot care for the cat, dog or bird, I must return it to ROFF and a refund will be made at the discretion of the ROFF Board Of Directors.